Condoms and HIV/AIDS Testing on the Road in Djibouti

Zahra Daher displays a picture used in HIV/AIDS training.
Zahra Daher displays a picture used in HIV/AIDS training.
Carole Douglis, USAID
International truck stop reaps health services
“When someone found out they had HIV/AIDS ... they would often kill themselves.”

“When we first started talking about HIV and AIDS, people would throw stones at us and chase us away,” says Zahra Daher. “It was as if by telling them about it we were bringing them the infection.”

Daher is head of the women’s group Alhamdou—“Thanks to God” in Somali. In 2004, she was one of few who dared mention HIV/AIDS despite the sizeable number of people dying from it in her community, the site of a large, international truck stop.

Then, as now, thousands of Ethiopian truckers a week parked here for days, waiting to load consignments from the Port of Djibouti. No prevention education, no testing or counseling, no treatment were available at the “PK-12” settlement, named for its 12-kilometer distance from central Djibouti town. Despite a thriving sex trade, condoms were a taboo subject.

“When someone found out they had HIV/AIDS—and that wouldn’t happen until they ended up at the hospital with some other disease and got tested—they would often kill themselves,” says Daher.

But men who a decade ago literally preached, “We must stop these people,” are now close allies in the fight to free the community of HIV/AIDS.

“The women’s and youth associations came to us and said, ‘We’re doing this work. You all know the problem in the community. And we really need your help.’  As leaders, we decided to work with the associations, even though our congregations were nervous,” says Imam Osman Ali, a cleric from PK-12.

Thanks to support from USAID/Djibouti, in 2005, Family Health International (FHI 360) provided training in HIV/AIDS education to Alhamdou, the youth group Massabu (“Equality” in the Afar language), plus seven imams from local mosques. 

“We pray five times a day, plus most of Friday,” said Imam Ali. “We now use all of these as opportunities to preach against adultery and for abstention. We also work hard to convince people to get tested so that they can get help if they need it.”

While not advocating the use of condoms unless one partner of a couple is positive and the other negative, the clerics also direct their congregants to the PK-12 “SafeTStop."

At the SafeTStop—one shipping container atop another, marked with faded HIV-prevention billboards—community members and truckers can learn about prevention, pick up condoms, join a support group, and get referred to a nearby health facility for testing. They can also take a break with a ping-pong game or a video—recreation that draws clients and helps truck drivers pass the time.

Soon PK-12 will have a new, larger SafeTStop to offer voluntary HIV testing, counseling and other health services on-site.  Due to open in late 2013, the new center represents a public-private partnership between USAID, the Djibouti Ministry of Health, FHI 360, and the port operator, Dubai Ports World.

Truckers are looking forward to the new facility. "This place is very helpful," said one Ethiopian driver at the container, "especially to get condoms. But to actually get tested and counseled, you have to go through town to a clinic. It will be very good to have it all in one place."

In the meantime, anecdotal evidence suggests that HIV/AIDS has dropped dramatically in the last few years around PK-12. Noting a sea change in attitudes, Hussein Houmed Mohammed, president of Association Massaba, says, “Today, people approach us.  People go for testing and go back for the results.  Every young person around here has condoms in their pocket.”